The rules, which were issued by the Medical Licensing Board of Indiana, took effect this month.

Now, long-term pain patients must sign medication agreements and submit to drug tests. Their doctors must assess the patient's substance abuse risk, prescription history and other factors.

The rules cover patients who are prescribed more than 60 opioid-containing pills a month; or a morphine equivalent dose of more than 15 milligrams per day; for more than three months. It does not apply to people who take such medicines for less than three months, or to patients who are terminally ill.

Some details of the new requirements:

* At the beginning of treatment, and at least annually after that, doctors must run an INSPECT report on each patient. INSPECT (Indiana Scheduled Prescription Electronic Collecting & Tracking), is a database of controlled substance prescriptions filled at Indiana pharmacies.

* Doctor and patient must sign a treatment agreement. The document must include certain information including the patient's consent to drug testing; the patient's promise to take the medicine as prescribed; and authorization for the doctor to conduct random pill counts.

* The doctor must assess the patient's mental health status and substance-abuse risk.

* Patients must see their doctor for a visit at least once every four months.

* To confirm that medicine is being taken as prescribed, the patient must submit to annual drug tests.

All of these provisions are part of a larger effort to cut down on prescription drug abuse in Indiana.

Last year, Indiana Attorney General Greg Zoeller established the Indiana Prescription Drug Abuse Task Force, which is made up of state legislators, law enforcement officials, health care providers and others. The group's goal is to reduce the abuse of prescription drugs, and cut down on the number of related deaths.